GUIDELINE - World Health Organization

1 GUIDELINEP rotecting, promoting and supportingBREASTFEEDING IN FACILITIES providing maternity and newborn services2017 Protecting, promoting and supportingBREASTFEEDING IN FACILITIES providing maternity and newborn servicesGUIDELINE: GUIDELINE : protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn servicesGuideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn 978-92-4-155008-6 World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike IGO licence (CC BY-NC-SA IGO; ). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific Organization , products or services.

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4 The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design and typesetting by Christopher Yuen. Front cover photo by Tom by the WHO Document Production Service, Geneva, : protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn servicesPublication history ivAcknowledgements ivFinancial support vExecutive summary viPurpose of the GUIDELINE viiGuideline development methodology viiiAvailable evidence viiiRecommendations ixRemarks xResearch gaps xiPlans for updating the

5 GUIDELINE xiiIntroduction 1 Objectives 2 Scope 2 Target audience 2 Population of interest 3 priority questions 3 Outcomes of interest 4 Presentation of the recommendations 4 Description of the interventions 5 Evidence and recommendations 8 summary of considerations common to all recommendations 8 Immediate support to initiate and establish breastfeeding 9 Feeding practices and additional needs of infants 16 Creating an enabling environment 22 Implementation of the GUIDELINE 28 Implementation considerations 28 Regulatory considerations 28 Ethical and equity considerations 28 Monitoring and evaluation of GUIDELINE implementation 29 Research gaps 30 GUIDELINE development process 31 WHO steering group 31 GUIDELINE development group 31 External resource persons 31 Systematic review teams 31 Management of conflicts of interests 32 Identification of priority questions and outcomes 33 ContentsGuideline.

6 Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn servicesEvidence identification and retrieval 33 Quality assessment and grading of evidence 33 Formulation of recommendations 34 Consensus decision-making rules and procedures 35 Document preparation and peer-review 35 Dissemination and plans for updating 36 Dissemination 36 Plans for updating the GUIDELINE 36 References 37 Annex 1. Question in population, intervention, comparator, outcomes (PICO) format 52A.

7 Immediate support to initiate and establish breastfeeding 52B. Feeding practices and additional needs of infants 55C. Creating an enabling environment 57 Annex 2. Systematic review details 61A. Immediate support to initiate and establish breastfeeding 61B. Feeding practices and additional needs of infants 65C. Creating an enabling environment 69 Annex 3. GRADE summary of findings tables 72A. Immediate support to initiate and establish breastfeeding 72B. Feeding practices and additional needs of infants 83C. Creating an enabling environment 91 Annex 4. GRADE-CERQual summary of qualitative findings tables on values and preferences of mothers 97A. Immediate support to initiate and establish breastfeeding 97B. Feeding practices and additional needs of infants 101C. Creating an enabling environment 103 Annex 5. GRADE-CERQual summary of qualitative findings tables on acceptability among Health workers and stakeholders 105A.

8 Immediate support to initiate and establish breastfeeding 105B. Feeding practices and additional needs of infants 109C. Creating an enabling environment 111 Annex 6. WHO steering group 114 Annex 7. WHO GUIDELINE development group 115 Annex 8. External resource persons 116 Annex 9. Systematic reviews and authors 117 Annex 10. Peer-reviewers 119 Annex 11. WHO Secretariat 120 GUIDELINE : protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn servicesivPublication historyThis GUIDELINE , Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services is an update of, and supersedes, the Ten Steps to Successful breastfeeding , as published in a joint statement by the World Health Organization (WHO) and the United Nations Children s Fund (UNICEF) Protecting, promoting and supporting breastfeeding : the special role of maternity services in 1989.

9 This complements the operational guidance of the Innocenti Declaration on the protection , promotion and support of breastfeeding , published in 1990 and the Innocenti Declaration 2005 on infant and young child feeding, published in 2005. It also complements some of the implementation guidance of the Baby-friendly Hospital Initiative, published in 1991 and updated in 2009 (only inasmuch as aspects of the Ten Steps to Successful breastfeeding remain unchanged).In order to produce this GUIDELINE , the rigorous procedures described in the WHO handbook for GUIDELINE development were followed. This document presents the direct and indirect evidence, as well as the qualitative reviews that served to inform the recommendations herein. It expands the sections on dissemination as well as those on ethical and equity considerations, summarized in the most recent reviews those on these GUIDELINE was coordinated by the WHO Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development.

10 Dr Pura Rayco-Solon and Dr Juan Pablo Pe a-Rosas oversaw the preparation of this acknowledges the technical guidance from the members of the WHO steering committee for this normative work (in alphabetical order): Ms Maaike Arts (UNICEF), Dr Shannon Barkley (Department of Service Delivery and Safety), Dr Bernadette Daelmans (Department of Maternal, Newborn, Child and Adolescent Health ), Dr Laurence Grummer-Strawn, Dr Juan Pablo Pe a-Rosas, Dr Pura Rayco-Solon (Department of Nutrition for Health and Development), Dr zge Tuncalp (Department of Reproductive Health and Research) and Mr Gerardo Zamora (Gender, Equity and Human Rights Team). We also would like to express thanks for the technical contributions to this GUIDELINE of the following individuals (in alphabetical order): Ms Jane Badham, Ms Kelly Brown, Ms Evelyn Boy-Mena, Ms Elizabeth Centeno Tablante, Dr Lisa Rogers, Dr Nigel Rollins, Dr Yo Takemoto and Mr Gerardo would like to express our gratitude to Dr Susan Norris from the WHO Guidelines Review Committee Secretariat and members of the Guidelines Review Committee for their technical support throughout the process.